PROJECT SUMMARY The overarching aim of this study is to inform our understanding of the structural changes in the velum and to describe the functional effects to the velopharyngeal portal caused by pedicled buccal fat pad graft (BFP) used during primary cleft palate repair. More specifically, we will compare this procedure to non-BFP surgical cases and normal anatomy to determine if the use of a BFP during primary palate repair creates a more favorable velopharyngeal system for speech production compared to traditional methods. The Centers for Disease Control recently estimated that 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip with or without a cleft palate each year in the United States. Children born with a cleft palate typically undergo primary reconstruction of the palate between 6-12 months of age; however, it is estimated that 25-37% of these children will need a second surgery to eliminate hypernasal speech. Studies have described the use of the BFP at the time of primary palate repair, hypothesizing that this technique results in an increase in vascularized tissue within an otherwise denuded space at the posterior hard palate. In such, it was expected that this increase in volume and vascularity provided by the BFP would prevent wound contracture, thus maintaining a longer velum and optimizing maxillary growth. There have also been claims that this technique will result in increased velar length, which is a known predictor of successful speech outcomes and normal velopharyngeal function for speech. These hypotheses regarding velar lengthening, decrease in velar scar composition, and thus improved velar function have not been systematically examined and compared to children with cleft palate not receiving BFP nor children without cleft palate. The effect the BFP has on palatal and velopharyngeal anatomy is currently unknown. Furthermore, no studies to date have applied magnetic resonance imaging (MRI) methods to examine the tissue composition and structural and functional changes as a result of the BFP. The purpose of this study is to use MRI to examine the surgical impact of the BFP on velar composition and velopharyngeal anatomy after it is placed at the palatine aponeurosis at the time of primary palate repair. These findings will be compared to our pre-existing database of aged-matched controls with normal velopharyngeal anatomy and our database of children with repaired cleft palate who have received traditional surgical procedures. The long-term goal of this study is to improve our understanding of the application of BFP in cleft palate repair and evaluate the outcomes compared to those not receiving BFP and to normative data, which is in line with the NIH?s mission to acquire new knowledge to treat and help prevent additional surgeries for individuals born with cleft palate.